Electrocautery

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Electrocautery
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Terms Related to Electrocautery

• ECU electrocautery unit
• Cautery and Bovie are used interchangeably to
  describe the cautery pencil or active electrode
• FYI Bovie is the originator of electrocautery
  surgery, hence called a Bovie sometimes
• Electro- (electrical/electricity)
• Cauterize (stoppage of bleeding)

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Electricity Terms Current, Volts, OHMs Law

• Electrical Circuit
• Hot Wire -wire that connects to the switch
• Neutral Wire serves as pathway for electrons to
  return to the energy source, completing the
  circuit
• Ground Wire separate wire that safely conveys
  any leaking electrons to the ground, preventing
  injury to the patient or personnel
• Must have a ground wire to prevent electric shock

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Electricity Terms Current, Volts, OHMs Law

• Wall Outlets
• 110V generally
• Mobile X-Ray 220V
• Surgical outlet must have three prongs in surgery
• First prong (positive)
• Second prong (negative)
• Third prong (ground)
• Wall plates that are red are hooked up to the
  hospital generator and you will plug important
  electrical devices into those outlets that are
  vital to the patient and their surgery

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Electricity Terms Current, Volts, OHMs Law

• Electrical Systems
• 1. DC (direct current)
• Flows in one direction from negative pole to
  positive pole
• Flashlight is an example of a DC system
• AC (alternating current)
• Flow of current reverses periodically
• One complete cycle occurs when the current moves
  in one direction then reverses its course
• One AC cycle is called a Hertz (Hz)

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Electrosurgery

• Electrocautery and electrosurgery do not mean the
  same thing (will hear terms used interchangeably)
  
• ESU s cut and coag/ ECU s coag ONLY
• Electrocautery is using a heated wire to burn the
  patients tissue (eye cautery)
• Uses DC current, no electricity enters the
  patients body

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Electrosurgery

• Two types ESU Bipolar and Monopolar
• Bipolar used for delicate procedures where there
  is moisture and a potential for nerve damage
• Active and Dispersive electrodes are the tines of
  a two prong forceps
• Monopolar is used for large surgical areas

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Electrosurgery

• Application or use of an electrical current to
  cut or coagulate tissue
• Uses AC current
• ESU Components
• Generator, optional foot pedal, cords, active
  electrode, and inactive dispersive electrode

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Electrosurgery

• ESU Circuit
• ESU generator
• Conductor cord
• Active electrode (pencil)
• Surgical site
• Patient (not part of circuit with bipolar)
• Dispersive electrode (grounding pad with
  monopolar other tine of forcep with bipolar)
• Conductor cord
• ESU Generator

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Electrosurgery Hazards

• Burns to the surgeon, surgeon assistants, STSR
• Burns to the patient from poor grounding pad
  placement, pad becoming loose due to oils, hair,
  air pockets, or prep-solutions
• Cautery plume vaporized tissue contains
  carcinogens, BBP, and mutagens
• Smoke evacuators should be used to counteract
  these hazards
• Contain an air and charcoal filter

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Basic Electrical Safety Guidelines

• Remove jewelry when operating equipment
• Secure long hair and loose clothing around power
  equipment
• Wear PPE prn
• Use equipment for intended purpose only
• Never use equipment you are not trained to use
• Inspect equipment prior to use
• Disconnect power prior to maintenance on
  equipment
• TURN OFF equipment power prior to unplugging or
  plugging in equipment
• Never disconnect a plug by pulling on cord (pull
  on plug)
• Hands should be DRY prior to handling equipment
  or cords/plugs
• Keep equipment out of line of traffic to avoid
  injury to person or equipment
• Tape cords down to floor if they are in traffic
  to avoid tripping

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Electrical Safety Guidelines

• Do not use electrical equipment when youre
  touching metal or water
• Unplug electrical equipment before cleaning,
  inspecting, repairing, or removing anything from
  them
• Keep electrical equipment areas clean/free from
  flammable materials
• Keep access panels and junction boxes clear
• Know where fuse boxes and circuit breakers are
• Make certain all electrical equipment is grounded
• Do not use water on electrical fires
• Report unsafe conditions/equipment to supervisor
  or biomedical/engineering department stat (Know
  policy of institution regarding damaged
  equipment)

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Valleylab Generator

• Features of the monopolar generator
• Cutting and coagulation settings available
• Bipolar available on left of unit with separate
  settings
• Settings average on 0-50 cut and 30-70 coag
  (surgeon preference)
• Standard settings 30/30
• Constant increase requests by surgeon mean
  something is wrong
• Troubleshooting problems Tip must be checked,
  connections checked, if cannot resolve obtain a
  new bovie pencil first, change ground
  (circulator) change generator

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Bovie scratch pad For non-teflon tips
Teflon tip and bovie cleaner
Bovie Pencil
Bovie holster
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Pediatric Grounding Pad
Adult Grounding Pad
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Non-disposable Tips
Bayonet forcep
McPhersons bipolar forcep
Disposable Ophthalmic Forceps Place in sharps
container at end of case
Bipolar Cautery Tips And disposable cord
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EYE Cautery or High Temp Cautery Battery
powered Used in Eye Surgery or Peripheral
vascular surgery When a hole is needed in a
synthetic Dacron graft These cannot be cut as
the material will fray, so hole may be burned to
seal the area
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Electrocautery Review

• Monopolar
• Current travels from generator, to active
  electrode (cautery pencil), to patient (wound),
  to inactive or dispersive electrode (grounding
  pad), back to generator
• All components must be present to avoid injury to
  patient and to utilize device
• Grounding pad placement must be on a fleshy,
  non-hairy, non-moist area where it is firmly
  stuck to skin
• Ground is placed by circulator

• Bipolar
• Current travels tip (active electrode) to tip
  (dispersive electrode) and is powered by a
  generator
• No grounding pad is needed
• Utilized when a precise cauterization is needed
  in delicate procedures such as ophthalmic and
  neurosurgical where precision is key
• Can have a bipolar with an irrigating port, seen
  most frequently in neuro procedures with a
  Bayonet style forcep (Malis Bipolar unit)

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Monopolar Cautery

• Various tips available long, short, needle tip,
  teflon coated
• Come in various colors depending on manufacturer
• May be hand cautery or foot pedal controlled
• Grounding pads must be appropriate size for
  patient (adult and pediatric available)
• NEVER cut a grounding pad!

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Tourniquets

• Go to this site http//www.tourniquets.org
• and read
• tourniquet overview
• use and care sections
• 2. Also read in Textbook St for the ST

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Tourniquet Components

• Esmark
• Tourniquet Cuff (sterile disposable or clean
  non-disposable)
• Pneumatic tourniquet machine

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Safety Precautions

• Tourniquet inflation times
• 1 hour for upper extremities
• 1 ½ to 2 hours lower extremities
• Times exceeding these recommendations put the
  patient at risk for nerve damage and or tissue
  ischemia (poor oxygenation/vascular compromise)
  which can cause tissue necrosis
• Tourniquets may be deflated for 10 minutes and
  then re-inflated if necessary

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Safety Precautions Continued

• Tourniquet pressures
• Must not exceed 50-75 mm/Hg over patients
  systolic blood pressure for upper extremities
• Must not exceed 100-150 mm/Hg over patients
  systolic blood pressure for lower extremities

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